Primary Care Associateshttp://www.primarycareak.com/blog
Wed, 16 Jan 2013 17:32:50 +0000enhourly1http://wordpress.org/?v=3.2.1How Your Pets Can Help You Live Longerhttp://www.primarycareak.com/blog/index.php/2013/01/how-your-pets-can-help-you-live-longer/
http://www.primarycareak.com/blog/index.php/2013/01/how-your-pets-can-help-you-live-longer/#commentsWed, 16 Jan 2013 17:32:50 +0000ushealthworkshttp://www.primarycareak.com/blog/?p=284Continue reading →]]>People love their pets for more reasons than they can think of. They feel joy from that special connection and the loving interactions between owner and animal. New studies are showing that there is another reason to love your pet that you should remember everyday. They help prolong your life. Researchers say that having pets helps people have lower stress levels, decreases blood pressure, helps balance cholesterol levels, boosts your mood, and improves immunity. All of this together can help add years to your life.
Here are 4 ways that your furry friends are helping you live longer!1. Pets help your heart: Our pets don’t only melt our hearts, they help them! The medical Journal of Australia reported that those who have pets have lower blood pressure, triglycerides, and cholesterol levels than those who don’t. Pet owners have also been found to have a more speedy recovery after surgery from this type of companionship.2. Pets keep you active: Your pets keep you moving. Studies show that people with dogs exercise more often than those without. Who needs a trainer and a gym when you have a dog and a park? By taking your dog out your getting that much needed cardio exercise to keep your heart healthy, a daily dose of vitamin D thanks to being out in the beautiful sunshine to keep your spirits high and your mood up! Who wouldn’t want that?3. Pets improve your immune systems: Laughter from the excitement and joy that pets bring, releases a chemical in the brain that improves immune functions. Even, petting something soft and furry like your animals has been shown to improve immunities.4. Pets relieve stress: Even the worst day can be forgotten the second you walk in the door and are greeted by your loving pet, who is so excited to see you. Interaction with your pet reduces overall stress levels by helping the body calm and rest. Good company equals less stress and less stress equals longer life. Now that’s an equation we can all understand!

Now those are reasons to love your pet! Not that you didn’t already. Don’t have a pet? Don’t worry! Most shelters allow people to volunteer and help out with the animals. This is a great way to get your pet fix if you don’t own one. Who knows, maybe you will fall in love with one while volunteering and decide to adopt. It’s a win/win no matter what!

]]>http://www.primarycareak.com/blog/index.php/2013/01/how-your-pets-can-help-you-live-longer/feed/0China 1980 / America 2012http://www.primarycareak.com/blog/index.php/2012/07/china-1980-america-2012/
http://www.primarycareak.com/blog/index.php/2012/07/china-1980-america-2012/#commentsTue, 10 Jul 2012 21:06:34 +0000ushealthworkshttp://www.primarycareak.com/blog/?p=260Continue reading →]]>In 1980 I joined a group of physicians who were invited to China. It was not that long after the “Gang of 4″ had been ousted and Nixon’s visit; China’s new leadership had decided to start limited access to the West, beginning with “professionals” escorted and contained by government employed guides.

We spent two weeks, toured several medical facilities, in Shanghai and Beijing, and in lesser cities and at extreme rural sites. We met with what was presented as China’s state of the art medical care and saw that it was housed in what would be considered 1950′s era American facilities equipped with a spectrum of vintage equipment. We accompanied the ‘barefoot doctors’ and saw how they picked from their herb gardens to treat their patients with blended herbs, and leaves, and roots. We saw demonstrations of acupuncture, moxibustion, alongside western-style procedures and pharmaceuticals.

We came back and put together a very forgettable article that was published in an obscure medical journal. Today I don’t recall what were our conclusions or even many of the details of our observations except as I can piece them together by looking at old photographs.

At that time there was no need for color film. Everything about China was in the 17 shades from absolute black to a nascent shade of pale. To be fair some color existed: the flowers of infrequent small gardens, tended by either a tired green or a dull blue uniform worn by every single Chinese citizen.

What remained with me from that trip 32 years ago was what happened when one of our group suddenly developed chest pain. Naturally, we were concerned he was having a heart attack. We were in a semi-rural area and our Chinese hosts immediately took us to the “emergency room” of the local hospital. The primitive equipment and limited pharmaceuticals aside, what most impressed me was who became involved in our colleague’s care. Very soon after we arrived and before our exam and an electrocardiogram suggested that our friend was indeed likely having a serious heart problem, 4 Chinese officials had entered the exam room. We were stunned as they had immediately begun chattering among themselves.

We asked who they were and what they were talking about and why they were crowding into an already cramped, unventilated and muggy room.

Our Chinese translator introduced us to the hospital administrator, his assistant, a local government liaison officer and one other minion whose role never was clearly defined. Not one of the individuals was a physician. The beaming local government official enthused that normal protocol was being followed and went into a short political speech about how our friend was getting exactly the same excellent care that was available to each and every Chinese citizen. He reassured us that, like all Chinese, our friend’s care was a committee decision and the disposition of our friend, whether to be hospitalized at that facility, or transported to another, and which facility that might be, and who might take over care, was being decided by this group of four with a fifth opinion of minor weight coming from the Chinese physician covering the emergency room that day.

After our group heard this we quickly arranged for a team from Hong Kong, of course then still a part of Britain, to fly and transport our patient/colleague to a proper facility, to be cared for by Western standards of diagnosis and treatment. We saw to it that he was safely transported; he required intensive care for 2 days before being allowed to travel home to the States for further treatment.

“A Wall Street Journal story the day after the Supreme Court ruling on ObamaCare examined in detail, its impact across the “health sector”. The words “doctor”, “physician”, and “nurse” appeared nowhere in this report. The piece, however, did cite the view of one CEO who runs a chain of hospitals (not-for-profit i.e. tax-exempt), explaining how they’d deal with ObamaCare’s expected 155 billion in compensation cuts. ‘We will make it up in volume’.

Apparently the new word for patients is “volume” and hospitals and clinics will be processing “volume”.Have you noticed what got lost in this historic rumble? Doctors. Remember them? ObamaCare has been a war over the processing of insurance claims. It has been fought by institutional interests representing insurance, hospital and pharmaceutical firms.” (Henninger WSJ July 5, 2012)

After more than 3 decades I’ve finally figured out who was that 4th non-physician minion in that claustrophobic Chinese treatment room.

Who might you think he was?

“Light Reading for Sick Rooms and Parties”

by: Bruce Kiessling, M.D. Just a G.P.

]]>http://www.primarycareak.com/blog/index.php/2012/07/china-1980-america-2012/feed/0Summer and Sunhttp://www.primarycareak.com/blog/index.php/2012/07/summer-and-sun/
http://www.primarycareak.com/blog/index.php/2012/07/summer-and-sun/#commentsTue, 03 Jul 2012 18:50:06 +0000ushealthworkshttp://www.primarycareak.com/blog/?p=248Continue reading →]]>It’s summertime and I have sunshine on the brain (pretty hard not to at 111degrees!)

Sunshine and thinking people have a “complicated relationship.” First, it is undeniably the giver of life. Without sunshine, Planet Earth would be close to absolute zero. Even the gases would be solid.

There would be no life at all, unless crystal growth counts. Yet this life-giving radiation is a source of wrinkles, aging, and the occasional cancer. Icarus syndrome, perhaps.

A suntan is the most visible effect of time spent in the sun. The ability to suntan is, like so many other things in life, fundamentally unfair (blame it on your parents). Melanin is the stuff of suntans. It is pigment made by your skin cells in response to ultraviolet radiation. It protects your skin cells from genetic damage.

The amount of melanin you start with is hereditary. If your people hail from Ireland, you have so little melanin that you can sunburn just thinking about a sunny day. If your blood calls Persia home, beach volleyball is your friend.

Suntans have not always been popular. As recently as a couple of generations ago, a suntan was considered evidence of an outdoor career, i.e. farm labor.

People went to extremes to appear pale; not only avoiding sun exposure, but applying somewhat poisonous bleaching chemicals to their skin.

Fast forward to the ‘70s and suntans are back in fashion. The “California look;” all blond and suntanned, seizes the public consciousness. Rickets almost disappears; and unemployed doctors go into dermatology.

Sunblock was invented in response to all this healthy glow; our schizophrenic thing with sun again. And someone decided to dice up the ultraviolet spectrum, forever confusing even smart people. Truth in advertising, SPF reform, hasn’t caught up with the sunblock industry yet, although the FDA is threatening. Smear this on and take 20 years off your skin.

Sunshine is made of infrared, visible and a couple hundred wavelengths of ultraviolet radiation. Infrared keeps you warm and cozy, like a lizard on a sunny rock. Visible light makes things look good, avoids broken legs, and gives you an excuse to wear cool sunglasses. Ultraviolet radiation is the pesky part. It is higher energy radiation and can breakdown the DNA in your skin, which keeps dermatologists employed.

When we talk ultraviolet radiation (UV), we are mostly talking about UVB (280-320 nm). UVB is blocked by the ozone layer and sunblock (mostly). It will give you a bad sunburn, and perhaps worse – old, saggy, wrinkled skin, age spots or cancer.

But UVB also stimulates vitamin D production; which is a free radical scavenger with anti-cancer properties. It also stimulates melanin production, which is the ultimate sunblock.

UVA is the latest thing. It is a little higher frequency than B (UVA 320-400nm). It comes down on us all daylight hours in all seasons. It is not blocked by the ozone layer or by most sunblocks. UVA oxidizes melanin which darkens it, gives you some quick color, but no sunburn protection. Oxidized melanin doesn’t stop UV anything. You need more melanin, not just a different color of melanin. UVA doesn’t directly damage DNA – it creates free radicals, which may be worse.

There is a great deal of research being done on new sunblocks effective against both UVA and UVB. Living in the desert we have learned to live in peace with the sun. Sunblocks, shade, Gatorade and cool sunglasses are a part of our lives. I draw the line at funny little sun umbrellas, not until I’m much older.

Excellent, reproducible, ethical science has demonstrated that the danger posed by radio waves is misplaced. But a vocal minority remain convinced otherwise.

The bureaucratic bickering at the World Health Organization (WHO) hasn’t helped.

“Let it be said once and for all, that no matter how powerful a radio transmitter-whether an over the horizon radar station or a microwave tower- radio waves simply cannot produce ionizing radiation” ( Economist Review Article 9/4/2011)

The only possible effect radio waves can have on human tissue is to raise its temperature slightly. In the real world the only sources of ionizing radiation (the type of radiation that harms human tissue) are gamma rays, X-rays, and extreme Ultra-Violet waves, along with fission fragments from atoms and cosmic rays from outer space. These are the sole sources of radiation sufficient to know electrons out of atoms, breaking chemical bonds and producing dangerous free radicals in the process.

So why did the WHO recently reverse itself on the question of mobile phones, reclassifying radio waves as a possible carcinogen pertaining to a perceived risk of brain cancer?

The International Agency for Research on Cancer, working for the WHO agreed that it had not been possible, after 10 years of intensive studies in 13 countries, to identify any health problems resulting from radio waves (also the raise in temperature of the skin caused by holding a phone close to the ear was found to be far far less than that cause by direct sunlight). But it was impossible to show categorically that there weren’t any risks. Because it is next to impossible to prove a negative (I have never been struck by lightening while in a mineshaft…but can I be sure it will never happen?) essentially the WHO is saying that even if a health risk exists, there is no way of ever ruling out chance, or other confounding circumstances with any degree of confidence.

Bottom line:
The whole brouhaha is a monumental irrelevance compared with the reprobates who insist on texting or talking while driving. Conservatively, and again with many studies to substantiate the conclusion, These activities are far far more likely to cause death or disfigurement. You already knew this. But did you know what you CAN do while your driving that allows you to pay attention to traffic and the road while also improving your health?

Try it weekly; set aside one sit-down meal a week as an experiment in mindfulness.

Insights may influence everything else you do.

. plant a garden and cook. Anything that reconnects you with the process of creating food will magnify mindfulness.

…chew patiently. It’s not easy but try to slow down, aiming for 25 to 30 chews for each mouthful.

…use flowers and candles. Put them on the table before dinner. Rituals that create a serene environment help foster what one advocate calls “that moment of gratitude”.

Few work environments are as frenetic and energized as the Google campus. Yet the hour long wordless vegan lunch started by Thich Hanh is a popular monthly observance.

Bottom Line:

What to eat: The Mediterranean Diet

How to eat: The Weight Watcher Way

When to eat: when you have the best opportunity to be mindful of the pleasure of eating in a slow, quiet, and appreciative fashion.

Bruce Kiessling, M.D.

‘Just a G.P.’

]]>http://www.primarycareak.com/blog/index.php/2012/05/tips-for-mindful-eating-stop-and-smell-the-pesto/feed/0Random Pearls to take to heart, or to educate/entertain/irritate othershttp://www.primarycareak.com/blog/index.php/2012/05/random-pearls-to-take-to-heart-or-to-educateentertainirritate-others/
http://www.primarycareak.com/blog/index.php/2012/05/random-pearls-to-take-to-heart-or-to-educateentertainirritate-others/#commentsTue, 22 May 2012 20:51:22 +0000ushealthworkshttp://www.primarycareak.com/blog/?p=219Continue reading →]]>Light Reading for Sick Rooms and Parties

Todays topic: Random pearls to take to heart, or to educate/entertain/irritate others. Hence the relevance in Sick Rooms and at Parties.

– Kids wear backpacks:
Risk for back pain is proportional to weight.
Recommended weight: less than 10% of their body weight.
What they carry: most often over 15% of their body weight.
Girls at higher risk for back pain than boys. No wonder 25% of kids complain of back pain.

– “Sit up Straight” may please your mom
Actually a straight up sitting position is not the best position at all. The best back position approximates a 135 degree angle (body-thigh) with the hips higher than the knees. When you lie down the discs in your back rehydrate and the nerve outlets are helped by the change of the curve of the back. The 135 degree position approximates most closely this position. Luxury car manufacturers have already started to incorporate this into their design. Until furniture makers take note, use adjustable desks and chairs, and footrests.

– Sleep is essential; sleeping pills are not
Sleeping pills are associated with greater than 3x increased hazards of death even when prescribed less than 18 pills/year.

Explanations for this include: mixing with alcohol, increased risk of depression/suicide, impairing of motor and cognitive skills suchas driving, hangover sedation increasing risk of falls, worsening of sleep apnea in some individuals which in turn increases their risk for heart failure, abnormal rhythms. These medications may cause sleep-walking night-eating syndromes, as well as other automaton-like behaviors which can be dangerous. Have a care with the use of sleeping medications and talk with your doctor about non-drug approaches to improved sleeping habits.

– Massage may accelerate healing
The relief that comes from rubbing sore muscles seems to have tangible roots: researchers have found clear molecular signs that overworked muscle cells respond to being manipulated by massage. There are measurable decreases in inflammatory compounds in massaged muscle tissue and indications that muscle cells rev up their energy processor for the inevitable repairs that follow hard exercise. (Feb1. Science Translational Medicine)

– Breslow obituary (April 16, age 97)
Dr. Breslow in the mid 20th century studied 6928 people and their behavior for 20 years. This most lauded of his studies was one of the first credible quantitative analyses of health and human behavior. It proved that a 45 year old with at least six of the seven healthy habits Breslow chose as important had a life expectancy 11 years longer than someone with three or four. The seven habits: do not smoke; drink in moderation, sleep 7 to 8 hours/night, near daily at least moderate exercise, eat regular meals (versus snacking or skipping), maintain a moderate weight (BMI < 27), eat breakfast.

A follow up study showed that those who followed these habits were less likely to become disabled. Of those with four or more good health habits, 12.2 percent were likely to be disabled 10 years after the study began; those with two or three 14.1 percent, and those with only one or no positive health habits at all 18.7 percent.

Breslow found that a 60 year old who had followed the seven recommended behaviors since age 45 would be as healthy as a 30-year-old who followed fewer than 3. Breslow practiced what he preached. He died at age 97 and enjoyed good health and mental alertness until the very end.

I refuse to belong to the AARP. Because I miss out on some discounts, I’m told I’m shooting myself in the foot. I don’t agree. Regarding the discounts, I find that in most instances it is a “senior discount” and not an AARP discount, and by just showing my driver’s license I get the break.

More important is that I am not supporting an organization that derives the majority of its income selling insurance which, by my analysis, willfully misrepresents its benefits and exploits its clients. Most important, the AARP purports to champion the cause of ‘everyone over 50′ (except me) by retaining the status quo for their revenue stream and to the detriment of choice for those over 65.

The unvarnished history, motivation, and business plan of the AARP is available to anyone willing to drill into the facts. I have discussed it on several occasions on my radio program, and I will present my arguments for my disdain of this group in a future blog. But, what deserves our immediate attention (unsupported by the AARP) and which is an immediate benefit to every senior, and to anyone who has a care about those 65 and older, is the support and passage of The Medicare Patient Empowerment Act (H.R. 1700 and S. 1042).

Growing bureaucratic burdens, inadequate payment rates that have not kept pace with the rising costs of providing care, annual threats of pay cuts and full patient schedules combine to make it increasingly difficult for doctors to continue seeing Medicare patients. While most doctors will continue to see long-tieme patients after they become eligible for Medicare, a growing number of them have already been forced to stop seeing new Medicare patients. As members of the baby boom generation enter Medicare and the nation’s doctor shortage gets worse, we can expect more and more seniors will find it difficult to see a new doctor. This legislation would ensure that seniors can see any doctor they choose, even if that doctor can not accept their Medicare.

Patient protections are built into the legislation including for very low-income patients who are eligible for both Medicare and Medicaid. And you must be told the cost of the care before it is provided.

The Problem:

Currently, seniors can only use their Medicare benefits to see physicians who accept Medicare insurance.

When seniors choose doctors who are not taking Medicare, they must pay the full cost of those services out their own pockets, usually up front at the time of service.

The Solution:

The Medicare Patient Empowerment Act would allow seniors to see any doctor they choose.

Seniors would not have to give up their Medicare benefit and pay for the full cost out-of-pocket

Seniors would not have to enroll in a new Medicare plan.

Under current law seniors are unable to use their benefits to see any doctor they wish. This isn’t right.

Medicare’s promise was that seniors would have access to health care when they needed it, and that the medicare benefit would support senior’s right to be cared for by any physician they choose. The Medicare Patient Empowerment Act requires the government to keep their promise and allow seniors to use their benefit to see any doctor they wish.

Bruce Kiessling, M.D.

‘just a G.P.’

To learn more about this topic, or to ask Dr. Kiessling questions directly, be sure to tune into 650 KENI at 12:30 pm (AK time) or listen live online. You can also call in at (907) 522-0650.

It may be worthwhile for the reader to review the recent two blogs on this subject. It may seem a bother, if not a tough slog, to familiarize yourself with the details of hormone replacement. Yet an uninformed recipient is an ill-advised patient. What you don’t understand in these blogs needs to be understood before you begin replacement. Copy this information, supplement it from reliable web sites (e.g. Mayo Clinic, CDC.gov) and review in detail with your physician.

In today’s third and final blog on testosterone replacement we will focus on 4 area: accurate testing, full disclosure, proper monitoring, and replacement options.

Accurate testing

Initial screening should include a test for Total Testosterone and Free Testosterone on a blood sample drawn in the morning. Testosterone levels are highest in the morning. Later, if replacement is deemed appropriate and started and the replacement is by injection, subsequent testing should be done 48 hours after injection as this will reflect peak levels. If replacement is done
by gel or patch, subsequent testing can be done at any time.

If Total or Free Testosterone is reported to be below the lowest normal (e.g. less than 200 when 200-1000units reflects the laboratory normal values) then a Leutinizing Hormone, Dihydrotestosterone, and a current PSA and Complete Blood Count should be obtained. Leutinizing Hormone is measured to determine if the low testosterone is due to a deficiency of the pituitary glad in its role to stimulate testosterone production in the testes. If Leutinizing Hormone is also low it does not mean that replacement is not indicated, but it does suggest that the pituitary gland should be studied further to determine if other hormones it regulates are not up to par.

Dihyrotestosterone levels are not required by every physician. I draw this because it has been found that blocking it can help men with enlarged prostate
symtoms, and male pattern hair loss, without compromising the muscle mass preservation that accompanies testosterone replacement.

Prostatic Specific Antigen is followed because testosterone stimulates prostate growth; any sudden rise of the PSA should be investigated further.

The Complete Blood Count, or more specifically the Red Blood Cell Count (hemoglobin and hematocrit) are measured and followed because testosterone
replacement increases red blood cell production. If the red cell count exceed normal range it will become a danger because it makes the blood “too thick”
and risks abnormal clotting.

Full Disclosure

Before starting the candidate should know what are the risks of testosterone replacement. The prostate will grow, and more rapidly resulting in potential
symptoms (decreased stream force, frequency (especially getting up in the middle of the night). The red blood count will likely increase and dosages may
need to be reduced or replacement eliminated altogether if the red cell count gets too high.

Because prostate cancer growth is stimulated by testosterone the greatest concern is that replacement would increase the risk of developing prostate cancer. This has been studied extensively for decades and no data supports an increased risk for cancer if replacement stays within the normal ranges. However
it does not decrease the risk for prostate cancer either which is why early diagnosis is important; testosterone replacement would be stopped with the diagnosis of prostate cancer. After treatment however, testosterone is sometimes restarted.

Proper Monitoring

Testing is done frequently the first year, both to determine response, monitor PSA and blood count, and assure that too much is not being prescribed.
Testing is a significant expense and many insurance companies balk at covering this service as well as replacement hormone. This is especially true when
baseline tests indicate clearly a low level (e.g. 220) but not quite below the considered lowest normal value. Frequently men will decide that they still
want the replacement to see what effect it will have on them, and then decide whether to “fight the insurance” or simply pay for it out of their own pocket.

After the first year and when proper dosing is determined, testing is done at 6 month intervals.

Replacement Options

All of my patients are given the option of testosterone injections. It is simple and incredibly less expensive than topical replacement. It also is arguably closer
to how the body works because topical testosterone is largely converted by enzymes in the skin to Dihydrotestosterone and circulates exclusively in that form until eventually metabolized. Testosterone injections however have at least one pass through the body as testosterone before being converted to dihydrotestosterone by the liver.

Aside from being 20 to 50 times more expensive than testosterone injections, the skin applied testosterone create important obligations. It is important that
it be applied in such a way that it does not come in contact with anyone else.

Testosterone injections are easy to administer and are done once a week. More frequently than that is not necessary, and less frequently can cause peaks and valleys of hormone levels noticed by the man.

However, some men are just not keen on giving themselves injections and the skin applied testosterone is the right thing for them.

Important: There are no oral preparations of testosterone that are not either useless (except in separating you from your money) or severely toxic.
Therefore there are no FDA approved oral testosterone products. Also there are no oral “precursor, stimulators, enhancers of testosterone”. DHEA (Dihydroepiandrosterone) is sometimes called “the mother of all (sex) hormones” because it is metabolized eventually to both testosterone and estrogen.

Athletes (Mark McGuire admitted as much) will take oral DHEA (legitimately available over the counter) in hopes that it will boost testosterone.
It may, but only for a short time, and then in men it often boosts estrogen as least as much or more. It is however used in women (low dose) to help
with their libido, because in the case of women the metabolism goes toward testosterone production. If it has a testosterone effect in women it is often accompanied by masculinizing changes (unwanted hair, voice…) that are not endearing to the woman.

Finally

The reader might get the impression from these discussions that testosterone replacement is dangerous. It can be, if not done properly. But that can be said about thyroid replacement, insulin replacement and any medical treatment.
I have helped hundreds of men in the assessment of their testosterone levels, suitability for replacement, and have dozens of male patients on testosterone replacement who appreciate excellent results in the context of all the requirements to do so safely.

Though I have devoted three blogs to this topic, they are not inclusive of many more important details that would need to be considered in the unique context of each individual. They are a good start however, in your discussions with your physician. Direct to consumer marketing by pharmaceutical companies is willfully misleading at worse, and grossly inadequate disclosure at best. These blogs are offered to help you with your due diligence before embarking on any voluntary drug treatment, including testosterone replacement.

2. Hair on forehead: Bangs in adolescence are associated with aggravation of acne via the oiliness of hair in contact with the skin. Hair should be held off the forehead during sleep.

Remember ‘Hands, Hair, and Hydration”. The dirtiest part of our bodies are our hands: keep them off your face. Get hair off the face too, at least during sleep. 2/3 of your body is water; skin is your largest organ. Help your skin by staying well hydrated (70-90 ounces/day)

3. Tight belts, tight pantyhose: can cause numbness in the leg by pressure on the lateral femoral cutaneous nerve that runs from the abdomen to the outer thigh. A similar problem occurs with policemen and journeymen who carry guns or equipment on their hips.

Symptoms includes numbness on the side of the leg, back pain sometimes radiating into the buttocks or hip. A fat wallet carried in the hip pocket is a common culprit for symptoms as well.

Victorian style corsets could crush ribs and interfere with digestion; today we have too tight jeans. “Tight Pants Syndrome” coined in 1993 can cause abdominal discomfort, distention, heartburn, and belching especially after eating. Also possible: low back pain, yeast infections in women and a condition known as lipoatrophia simicircularis (horizontal skin changes around the thighs, much more unwelcome appearing than cellulite).

Also, allergies occur more often with synthetics and blends than cloths that are all wool, silk or cotton. People who develop rashes from clothes are reacting to dyes and fabric softeners that can include formaldehyde. Washing new clothes a couple of times before wearing can reduce that.

7. Socks with tight elastic: can cause raised reddish welts around ankles. The marks are harmless but can last for years.

They can also occur around wrists from tight mittens.

8. Shoes with heels hight than two inches: are linked to bunions, hammer toes, stress fractures and ankle sprains.

Bony protrusions on the back of heels (“pump bumps”) can also develop, along with nerve damage between the toes (neuromas), and circulation blockage causing foot bones to die.

Do your shoe-buying after 3 or 4 in the afternoon when your feet are most swollen. Remember that one foot is larger than the other and size your shoes to that foot.

9. Years of wearing high heels: shortens the Achilles tendons making flat shoes uncomfortable.

Flats can lack support and lead to plantar fasciitis (pain that feels like you are stepping on a nail when you get up in the morning) .

10. Flip flops are worse: Wearers have to clench their toes to keep them on, leading to foot fatigue, sore calf muscles and an altered gait which could cause long term ankle and hip problems.

11. Heavy handbags and book bags: throw the back out of line, causing back and neck problems. Don’t carry more than 10% of your weight on a shoulder, and don’t do it long term without sharing the burden equally on both shoulders.

12. Body piercings: Over 20% of body piercings get infected. In my experience 80% of naval and nose piercings get inflamed or infected.

Also nickel allergy is common, and nickel even in very small amounts is included in rings, earrings, and watchbands. People who have no allergies to their jewelry can develop an allergy when exposed to citrus (e.g. lime or lemon). It is the combination of the acid in contact with nickel in the jewelry, and the allergy becomes a permanent one even without future exposure to the citrus. Sometimes the jewelry can still be worn if a layer of protection (e.g. fingernail polish) is applied to that part of the jewelry that contacts the skin (e.g. the back of a watch or ring).

13. Fingernail extensions and appliques: very, very frequently develop bacterial, and more often fungal infections.

Men have become more comfortable asking about erectile dysfunction ever since rhino horn and toad stash were replaced with the relentlessly advertised Viagra and Cialis.

These medications are very effective, but the symptom of erectile dysfunction often belies (50% of the time) an underlying blood flow problem to more than just the genitals. The penile artery is 3 mm; the coronary artery is 5 mm. If there are problems with blood flow to the penis, 50% of the time there are problems with blood flow elsewhere-from untreated high blood pressure, abnormal lipids (cholesterol), and/or diabetes.

Frequently the issue of disappointing erectile function prompts a man’s visit to the office where these important medical problems can be diagnosed and should be treated, along with the help provided via Viagra, Cialis, or Levitra. In other words, don’t risk buying Viagra from an uncertain source; find out if there’s more to your problem. Also if you are happy with the results of Viagra or Cialis, you’re not doing your buddy a favor by sharing; encourage him to get checked out as well while reassuring him that they really do work.

Performance problems not corrected by these medications, when stress, distraction, a marriage in conflict are ruled out, make us consider low testosterone as a possible contributing cause. Libido, the interest in sex, is mediated by emotion and physiology and therefore low testosterone can lower a man’s interest in sex just as it often does with women after menopause who have lost 50% of their testosterone levels with the disappearance of ovarian function. Viagra and Cialis need not only adequate blood flow, but also a sufficient supply of circulating testosterone. Women in their forties and fifties have asked their doctors about their symptoms and relationship to menopause since… well, at least since the1940′s and 50′s.

Men on the other hand almost never ask about the “andropause” (a flawed term meant to describe declining testosterone levels). It is likely this will change and men will begin to ask more about their testosterone levels with their physicians now that several branded topical testosterone preparations are available, all of which are very profitable to the pharmaceutical companies and which explains the extensive advertising. Yet legitimate testosterone replacement has been available at very low cost for decades.

Men 40 and under ask about testosterone almost always because of their goal to build muscle mass and strength, usually associated with athletic and competitive ambitions. When tested they are similarly almost always in excellent, normal range and are inappropriate candidates for testosterone replacement. Frustrated, they may seek illicit sources of questionable composition. By flooding their system with anabolic steroids (testosterone being only one of several illegal chemicals in this category) they risk many side effects, permanent organ damage, and toxicity.

A male in his 50′s could very well be noticing the lack of speed and endurance he had once enjoyed. But this is nearly always due to an abnormal weight and de-conditioning (‘out of shape’). Middle-age inflation gathers round the gut for men, and on the butt for women. Fat is not attractive in either locale but cradled over and under the belt it becomes an obnoxiously persistent metabolic parasite impairing availability and function of important hormones (including testosterone, insulin, and others).

In short,

▪ a man who is concerned about testosterone levels should get to ideal weight, or nearly so before being checked. Losing the weight makes every hormone he produces more available to do their job, and often raises testosterone levels in the process as well.

▪ he should also embark on a judiciously advanced fitness program (after being cleared by his physician if he’s been inactive for awhile, or has health risks). Fitness enhances the feel good hormones (endocanabinoids) and the effectiveness of circulating insulin and testosterone.

But we are a culture of immediate gratification and the sweat equity required to lose weight and get in shape is a tough sell when two thirds of our population is overweight, obese, and de-conditioned. My professional opinion (from 40 years of experience and study) is that offering testosterone replacement without a nutrition and fitness plan carried out beforehand, or at least simultaneously with replacement (and never above high-normal levels) is dangerous nonsense. It is trading an aging Volkswagen idling in the driveway for an elderly Ferrari also idling uselessly in the driveway: it is expensive, high maintenance pollution, and the touted benefits will neither be attained nor appreciated by the individual.

“Light reading for sick rooms and parties”

by B. Kiessling, M.D. “just a G.P.”

Founder/Medical Director, Primary Care Associates

To learn more about this topic, or to ask Dr. Kiessling questions directly, be sure to tune into 650 KENI tomorrow at 12:30 pm (AK time) or listen live online. You can also call in at (907) 522-0650.